This application is for a three-year, health care information technology implementation and evaluation project led by Mercy Medical Center-North Iowa, a rural secondary referral center, in collaboration with Hospice of North Iowa, the Mason City Clinic, Mercy Medical Center-Clinton, Trinity Health, and the University of Iowa Department of Health Management and Policy. The project partners will implement a comprehensive, integrated, electronic health record (EHR) system using new uniform data standards, with computerized physician order entry and clinical decision-support tools, in several diverse, rural, north Iowa health care settings (hospital inpatient units, ambulatory care, primary care and specialty clinics, home health, and hospice care) and will evaluate the impact of this EHR system on patient care and organizational culture. The project has four major goals: 1) to improve the quality of patient care and increase patient safety to be in the top quartile of JCAHO and CMS indicators; 2) to improve patient care workflow processes; 3 ) to enhance organizational culture and safety among the project partners; and 4) to generate significant organizational learning about the effectiveness of the EHR system and the implementation process. The University of Iowa Department of Health Management and Policy will conduct the project evaluation using Mercy Medical Center-Clinton as the control site. Evaluation measurements will include: a) reported medical errors (including medication errors) and near misses; b) CMS/JCAHO quality measures; c) physician/clinician use of standard evidence-based practices, responsiveness to adverse drug alerts, and use of computerized knowledge databases and other new information tools; d) patient satisfaction scores; and e) physician/clinician/staff assessments of the implementation process and how the electronic health record system has improved the quality and safety of patient care, communication among physicians, other clinical staff, and patients, and daily work life.